Economic Evaluation of the HEARTS Standardized Hypertension Treatment Program With Fixed-Dose Combination Pills in Chile Primary Care Clinics

Objectives In 2016, Chile implemented a pilot project in 2 Santiago-area family health centers aimed at improving hypertension control using the HEARTS framework for cardiovascular disease prevention. The core intervention replaced nonstandardized, single-medication regimens with standardized treatment using fixed-dose combination pills. Although prior studies demonstrate improved blood pressure control with fixed-dose combination pills, evidence on cost-effectiveness is essential for scalability. Methods A 10-year outcomes-based Markov model was used to assess the benefits and costs of the HEARTS approach versus usual care from a societal perspective. Incremental program costs were estimated via activity-based costing, and incremental benefits from reductions in acute CVD events. The cost-effectiveness was quantified using incremental benefit-cost ratios and incremental cost per averted disability-adjusted life-year. Results Although the HEARTS approach led to higher initial medication costs, averted CVD events generated net savings over time. The incremental benefit-cost ratio was estimated to exceed 1 by year 2 and reached 7.8 by year 10, showing that incremental benefits would exceed costs at an increasing rate over time. The cost per disability-adjusted life-year averted in model year 10 was approximately $2171, demonstrating high cost-effectiveness compared with the per-capita gross domestic product threshold. Conclusions The HEARTS approach in Chile, which uses a standardized hypertension treatment protocol with fixed-dose combination pills, was estimated to be highly cost-effective compared with usual care. It generates substantial net savings over time from estimated reductions in the incidence of acute cardiovascular disease events.